The Pharmaceutical Journal
Vol 269 No 7206 p52
13 July 2002

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Where will the hospital chief pharmacists of tomorrow come from?

By Simon Badcott

Whenever the media discuss the ills of the health service the cry goes up for more doctors and nurses and fewer managers. This sentiment should be a source of considerable unease for hospital pharmacists, not least because calls for additional health service staff inevitably omit pharmacists from the list but also because the future provision of hospital pharmacy managers should be giving the profession cause for concern. Within the background of the present general recruitment difficulties it is unsurprising that some senior pharmacy managers' positions have proved impossible to fill. What is more worrying is the general lack of enthusiasm among more junior staff to consider this as a future career option. Given the key role played by pharmacy managers this could have serious consequences. Where will the chief pharmacists of tomorrow come from?

Negative view of management

Although it is unsurprising that few preregistration trainees profess a burning ambition to be a chief pharmacist, many junior pharmacists do seem to hold a negative view of management as a career option. A quick (and extremely unscientific) poll of junior staff at a recent pharmacy meeting revealed a common perception that such roles are boring, bureaucratic and stressful, and higher salaries do not compensate for these shortcomings. This perception is in marked contrast to the view of the clinical specialist. It is now well established that medical specialties, such as intensive care and oncology, require the services of a dedicated clinical pharmacist. Many new posts have been created and as the first wave of specialist pharmacists have grown more experienced, grades for these posts have increased to reflect the additional contribution that these individuals have made, which has considerably reduced the financial inducement for these pharmacists to progress to a management position. There can be little doubt that clinical pharmacy is seen as the most "glamorous" branch of practice and by contrast those roles without direct patient contact are increasingly viewed as unattractive.

Another compounding factor that may deter the chief pharmacists of tomorrow is the lack of a clear training route, again in marked contrast to clinical pharmacy where the certificate/diploma/MSc progression is well established. The National Development Scheme for Senior Pharmacists has provided an invaluable introduction to management for a whole generation of recruits but, with this exception, management training specifically aimed at hospital pharmacists is at best patchy. General heath service management training is more widely available but owing to its broader remit may not necessarily provide the skills required. Continuing professional development (CPD) schemes work well in the context of clinical duties but may require imagination to apply to the development needs of a potential chief pharmacist. Finally, operational positions, such as dispensary managers, are increasingly being reallocated to pharmacy technicians, cutting out a traditional pathway to more senior management posts.

Why should this situation be of concern? On an individual level junior pharmacists may be missing out on a fulfilling career and the chance to shape the service of the future. For those who are capable of seeing the whole picture and exercising strategic, long-term thinking, the opportunities for innovation are limitless. On an operational level, addressing day-to-day issues requires well developed problem-solving skills and can be immensely rewarding, especially when a potential crisis has been effectively managed. Handling budgets, addressing staffing issues and developing services are all vital to the operation of a hospital pharmacy department. Leadership is essential in any organisation and it should be remembered that managers are contributing to patient care, albeit in an indirect but no less important way than the clinical team.

The provision of good managers in the hospital sector is just as important to pharmacy as a whole. The profession needs competent and enthusiastic champions to enable the vision for "Pharmacy in the future" to become a reality. Senior pharmacy managers provide the link between pharmacy and many external organisations and other disciplines. As such they are in an ideal position to influence the place of pharmacy services within the context of the broader health care environment.

To address the current situation effectively, action needs to be taken at both a local and a national level. Within individual hospital pharmacy departments there will always be a need for good role models. Managers must be positive and enthusiastic about their role and take every opportunity to provide support for those expressing an interest. Delegation of appropriate projects or tasks may provide an opportunity to test the water and start the development of valuable skills. This process can be facilitated within the framework of a suitable CPD scheme. As an added bonus such work can create a greater understanding between members of staff of each other's pressures and responsibilities.

Providers of training need to review the resources they provide for would-be managers and in particular consider a more structured approach to development. Consideration should also be given to providing a sufficient breadth of training and aiming to produce generalists as well as specialists. A head of department needs to understand the working of all sections and be able to take a broad overview of services. Rotational training programmes offer an excellent grounding but junior pharmacists should be encouraged to complete such programmes and resist the temptation to move on to a more highly graded but more specialist post before acquiring a broad basic knowledge. Staff at all levels should be encouraged to take an interest in a wide range of practice and develop a portfolio of transferable skills. It should be recognised that clinical and management functions may be successfully combined in some posts although at the highest levels time commitments may limit this option.

Positive view of management

And those initial accusations that managers' jobs are stressful, bureaucratic and boring? Responsibility always carries a certain degree of stress but learning to manage these pressures is an important skill that will prove valuable throughout a career. The labyrinthine complexity of many trusts can make even simple tasks frustratingly slow but there is a great deal of satisfaction in having achieved an objective despite an inefficient system.

There may also be the opportunity to facilitate change and help make such practices more effective. As for boredom, the sheer variety of work means that even if one task may appear dull another more interesting project will be just around the corner. Ultimately, like any job, a management position will be whatever the post holder makes it.

Despite the current situation we should not be too pessimistic about the future. The next generation of pharmacy managers is undoubtedly out there somewhere and the able but inexperienced pharmacist may be able to capitalise on a lack of suitable candidates and make rapid career progression. It is, however, a matter of regret that many individuals may be denying themselves a stimulating and rewarding career and a chance to influence the future of hospital pharmacy.

There, perhaps, is another point to ponder when confronted by the cry of "too many managers" and considering the more general provision of health service management. Without the recruitment and development of sufficient motivated, far-sighted and competent managers, there is little hope of the NHS delivering the quality of patient care that everyone desires.